Project Abstract: Candidate: Dr. Kenyon is a general pediatrician and asthma health services researcher at Children's Hospital of Philadelphia (CHOP), where he leads the CHOP Network's Asthma Population Health Workgroup. He completed a Masters of Science in Health Policy Research as a Robert Wood Johnson Clinical Scholar at the University of Pennsylvania. His long-term career goal is to become an independent investigator who leads a research program focused on improving outcomes and reducing outcome disparities for children with asthma using longitudinal health data to stratify and target high-risk populations for enrollment in well-designed and empirically rigorous interventions. His proposed project would facilitate this goal. Research: In this project, Dr. Kenyon proposes to build on promising preliminary data that demonstrates feasibility and robust engagement of high-risk childhood asthmatics in an iteratively developed mobile health technology intervention that leverages principles of behavioral economics to enhance inhaled corticosteroid medication adherence. His first aim is to determine the effects of different strategies of financial incentive withdrawal on adherence and health care utilization and cost in high-risk asthmatics ages 5-12 and their caregivers by conducting a three-arm randomized controlled trial. His specific hypotheses are that longer duration of financial incentive delivery, as well as medication adherence reminders and performance feedback, will lead to better immediate and enduring controller medication adherence, as well as less health system utilization and cost. In his second aim, he will investigate the potential mechanisms by which these intervention strategies influenced adherence trajectories, implementing group-based trajectory models to identify and study participants with sustained adherence. In his third aim, he will use mixed methods to explore caregiver and child perceptions of intervention component acceptability and their influence on controller adherence trajectory. Environment: CHOP has about 2,500 inpatient asthma admissions per year, the prevalence of asthma in CHOP's 31 practice Kid's First Network ranges from 20-25%, and all practices are on a unified electronic medical record with an asthma registry. This context provides a robust patient cohort and infrastructure for the proposed study. Dr. Kenyon has assembled a strong multidisciplinary team of experts in epidemiology and health services research (Drs. Feudtner and Asch), asthma outcomes and disparities research (Drs. Zorc and Bryant-Stephens), child behavior change/maintenance (Dr. Miller), medication adherence (Dr. Gross), and behavioral economics and health care innovation (Dr. Asch) to mentor and advise him through the planning and execution of this project. CHOP and the University of Pennsylvania are committed to the success of young investigators and have many unique resources to support the training plan and research of Dr. Kenyon, including the Center for Pediatric Clinical Effectiveness at CHOP and the Center for Clinical Epidemiology and Biostatistics and Center for Health Incentives and Behavioral Economics at Penn.